Feasibility of a “resect and watch” strategy with endoscopic resection for superficial pharyngeal cancer

BackgroundAfter endoscopic resection (ER) for superficial pharyngeal cancer (SPC), additional treatments such as radical surgical resection or radiation therapy may be needed in cases of possible incomplete resection. However, the benefit of prophylactic additional treatment is unclear.ObjectiveTo evaluate the feasibility of a “resect and watch” strategy with ER for SPC.DesignRetrospective, single-center cohort study.SettingTertiary cancer center.PatientsA total of 32 patients with 47 SPCs were eligible.InterventionA “resect and watch” strategy of initial ER and observation until development of secondary diseases, including local recurrence, neck lymph node metastasis (LNM), and metachronous pharyngeal cancer.Main Outcome MeasurementsComplications, tumor recurrence, development of metachronous pharyngeal cancer, overall survival, and cause-specific survival.ResultsThere were no severe complications related to ER. Median length of follow-up was 43 months (range, 7-76 months). Cumulative development of secondary diseases at 5 years was 44% (95% CI, 24.5%-63.8%). Local recurrence (N = 4) and neck LNM (N = 5) were successfully treated by local resection (2 partial surgical resections and 2 additional ERs) and neck dissection, respectively. Metachronous pharyngeal cancers (N = 6) were completely removed by ER. The overall survival and cause-specific survival rates at 5 years were 84.4% (95% CI, 70.0%-98.8%) and 100%, respectively. No patient needed radical surgery as an additional therapy. Thus, the larynx and its function were preserved in all patients.LimitationsRetrospective nature, single-center setting, relatively small sample size.ConclusionsA “resect and watch” strategy with ER for SPC is feasible and rational.